Non-anesthetist-administered moderate sedation with midazolam and fentanyl for outpatient MRI-aided hybrid intracavitary and interstitial brachytherapy in cervix cancer: a single-institution experience.

PURPOSE: The aim of the study was to determine the feasibility of interstitial brachytherapy under non-anesthetist-administered moderate sedation, to identify factors influencing the insertion, and the total procedural time. MATERIAL AND METHODS: A total of 47 insertions with hybrid intracavitary and interstitial applicators were performed in 23 patients from March 2017 to March 2020. Moderate sedation was achieved with intravenous midazolam and fentanyl administered by non-anesthetist. Insertion time and procedural time was recorded. Univariate and multivariate analysis were performed to evaluate the impact of different factors on insertion and procedural time. RESULTS: A total of 238 needles (range, 2-8 per insertion) were implanted, with an average insertion depth of 30 mm (range, 20-40 mm). The mean doses for midazolam and fentanyl were 3 mg (standard deviation [SD] = 1) and 53.3 mcg (SD = 23.9) per insertion, respectively. The median insertion time was 30 minutes (interquartile range [IQR] = 22-40), and the median total procedural time was 4.3 hours (IQR = 3.6-5.2). First time insertion, insertions performed before 2019, and higher midazolam dose were associated with significantly longer insertion time, whereas longer insertion time, MRI-based planning, and insertions performed before 2019 were associated with significantly longer total procedural time. CONCLUSIONS: Outpatient interstitial brachytherapy with non-anesthetist-administered sedation is achievable and well-tolerated. This method may significantly lessen the burden on hospital resources and has the potential to be cost-effective.

A checklist of the marine Anthuroidea (Crustacea: Isopoda: Cymothoida) from the reefs of Peninsular Malaysia, with some new distributional data.

BACKGROUND: An up-to-date checklist of the Peninsular Malaysian marine Anthuroidea is presented, based on previous taxonomic or ecological literature and recent collections. The present study, a part of the subproject on the Biodiversity of Sultan Iskandar Marine Park, recognised 24 species in 12 genera and 5 families from Peninsular Malaysia. An extensive list of bibliographical references, detailed information on habitat and distributional records, museum locations of type material are provided for each species. Amongst the listed species, 11 are recently discovered Malaysian species belonging to the genera Amakusanthura Nunomura, 1977, Apanthura Stebbing, 1900, Expanathura Wägele, 1981, Leptanthura G. O. Sars, 1897, Kupellonura Barnard, 1925, Pendanthura Menzies & Glynn, 1968 and Tinggianthura Chew, Rahim & bin Haji Ross, 2014. Our records were limited to shallow subtidal reefs of peninsular Malaysian coast, suggesting that the number of species in the list may rise with an extensive survey. NEW INFORMATION: The up-to-date checklist of marine Anthuroidea of the Peninsular Malaysia comprises 24 species in 12 genera and 5 families, including some new distributional data.

Tinggianthura alba: a new genus and species of Anthuridae (Isopoda, Cymothoida, Anthuroidea) from Pulau Tinggi, Johor, Malaysia with an updated key to the genera of Anthuridae.

A new anthurid isopod from dead coral rubble and stones in the intertidal area of Pulau Tinggi, Johor, Malaysia, is described. It is placed in a new genus and species, Tinggianthura alba. Tinggianthura is characterized by: (1) subtriangular carpus shape of pereopods 4-7, (2) pereopod 1 propodus palm without prominent tooth or steps and (3) maxillipedal palp 2-articled.

Schwannoma of the pulmonary artery.

Schwannoma (neurilemmoma) originating from the pulmonary artery has not before been described. A 65 year-old male presented with dyspnoea on exertion. CT scan was negative for pulmonary thromboembolism, but showed a well circumscribed, heterogeneous mass, 52 mm × 45 mm × 41 mm, straddling the left pulmonary artery and compressing the left atrium. The mass was found at surgery to be originating from the lateral wall of the left pulmonary artery. The tumour was completely resected, and the pulmonary artery reconstructed. The mass was found to be a benign schwannoma on histopathology.

A 7-year follow-up of patellar tendon and hamstring tendon grafts for arthroscopic anterior cruciate ligament reconstruction: differences and similarities.

BACKGROUND: For arthroscopic anterior cruciate ligament reconstruction, the most commonly used graft constructs are either the hamstring tendon or patellar tendon. Well-controlled, long-term studies are needed to determine the differences between the 2 materials. HYPOTHESIS: There is a difference between hamstring and patellar tendon grafts in the clinical results of anterior cruciate ligament reconstructions at 7 years. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Two groups of 90 patients each, consecutively treated with hamstring or patellar tendon grafts, were followed and assessed at 1, 2, 5, and 7 years after surgery. RESULTS: At the 7-year review, abnormal radiographic findings were seen in 45% (24/53) of the patellar tendon group and in 14% (7/51) of the hamstring tendon group (P = .002). Although there was no significant difference between the groups in extension deficit (P = .22), the percentage of patients with an extension deficit increased significantly in the patellar tendon group from 8% at 1 year to 25% at 7 years (P = .02). No significant change was seen in the hamstring tendon group over time (P = .20). There was no significant difference in laxity between the groups on Lachman (P = .44), pivot-shift (P = .39), or instrumented (P = .44) testing. Graft rupture occurred in 4 patients from the patellar tendon group and in 9 patients from the hamstring tendon group (P = .15). Both autografts gave excellent subjective results, as evidenced by the International Knee Documentation Committee evaluation and Lysholm knee scores at 7 years. CONCLUSIONS: Both hamstring and patellar tendon grafts provided good subjective outcomes and objective stability at 7 years. No significant differences in the rate of graft rupture or contralateral anterior cruciate ligament rupture were identified. Patients with patellar tendon grafts had a greater prevalence of osteoarthritis at 7 years after surgery; therefore, the authors preferred hamstring tendons as the primary graft choice in anterior cruciate ligament reconstructions.